Critical Care: Neuro

Question 1

What are the first S/S of increased ICP?

Answer 1

1st= ALOC
2nd= Pupillary changes [3,4,6]

Late/Severe= Decerebrate/ Decorticate positioning

Question 2

Nursing interventions for a patient with increased ICP?

Answer 2

Actions: Control BG, Temp, Oxygenation, BP
[Pain medications, mannitol/hypertonic saline, sedation [propofol/ketamine/etomidate], Levo

Interventions: Elevate HOB, decrease stimulation, keep head midline, keep BP low + stimuli low, contact provider for craniotomy/craniectomy/ICP monitor or drain

Question 3

Following a craniotomy, what will we watch for and how will we treat?

Answer 3

Ensure no CSF leakage (halo sign), Tx with ABX + helmet to avoid injury to brain w/o skull

Question 4

What is Cushings Triad?

Answer 4

Bradycardia, Irregular RR, Hypertension

Question 5

What are S/S of brain death?

Answer 5

Fixed pupils:
Absent corneal reflexes (no eye closure)
Absent occulovestibular reflex (no eye movement to water in ear)
Absent occulocephalic reflex (dolls eyes)
Absent gag + cough reflex
body temp of 96.8 F, GCS of 5-6

Question 6

What fluid is contraindicated when caring for a patient with increased ICP?

Answer 6

D5W

Question 7

List the mild, moderate and severe levels of ICP

Answer 7

5-15= mild
20+ = moderate
50+ = severe

Question 8

Stroke Interventions:
Compare/Contrast for ischemic and hemorrhagic

Answer 8

Interventions (Ischemic):
Admin TPA within 3 hours of s/s onset
Bleeding precautions, monitor vitals/BG,

Interventions (Hemorrhagic):
Monitor for s/s of infection, further hemorrhage, begin DVT prophylaxis, keep HOB elevated + midline, insert foley (mannitol diuresis), rapidly reverse anticoagulants (Coumadin/Warfarin = Vitamin K), Labetalol to decrease BP

Both: Head CT, schedule swallow screen [Keep NPO], seizure precautions, stool softeners to prevent valsalva maneuvers, pain management

Question 9

How do you calculate + what is a normal CPP?

Answer 9

Calculation: CPP = MAP - ICP
Normal CPP = 60-80 mmHg

Question 10

If ICP was high and MAP was low, what would you administer?

Answer 10

Levophed to maintain adequate CPP

Question 11

What is the function of the brain stem?

Answer 11

HR
BP
Temp
[Vitals]

Question 12

What happens if someone receives an injury to their temporal lobe?

Answer 12

Epidural hematoma
LOC –> Lucid period –> LOC again as hematoma expands

[Auditory processing, memory, {Wernickes} receptive communication]
**Memory [10 second Tom]

Question 13

What are the functions of the frontal lobe?

Answer 13

“The Mama”- inappropriate actions
Motivation, Attention, Judgement, Problem-Solving, Expressive communication (BROCAS), personality

Question 14

What are the functions of the parietal lobe?

Answer 14

Sensory integration
Proprioception
Smell/Taste/Touch

Question 15

What is the function of the occipital lobe?

Answer 15

Vision

Question 16

What is the function of the cerebellum?

Answer 16

Balance

Question 17

In a stroke patient when would we not control their blood pressure?

Answer 17

If they were not getting TPA due to bodys natural BP compensation